Therapy adherence is a big problem in the medical community, with millions of pounds worth of medicines being wasted every year. Often, we blame the patient, as though failure to follow treatment directions is down to wilful disregard of advice given by their health care providers.
Research into health literacy shows a rather different picture, indicating that more patients would follow the instructions they are given if only they could actually understand them.
Low health literacy is prevalent throughout Europe and the United States. Research revealed that 43% of UK adults don’t have a great enough understanding of patient information materials to enable them to correctly take medication. If the information they’re given includes numbers, the percentage of those who don’t understand rises to a massive 61%. Even more telling is the research result that over 90% of the adult population in the UK cannot understand information that’s written above the reading level of that intended for 9 - 11 year olds.
While these numbers for low health literacy are high, they provide a sharp insight into the problem of low therapy adherence. And having this insight, there is plenty the pharma industry and wider medical community can do to tackle the problem and redress the literacy imbalance.
This shouldn’t be seen as “dumbing down”. Rather, it’s more a question of recognising that most people without medical training or education never have the opportunity to learn in-depth about anatomy, disease, treatment and prevention.
The solutions are relatively simple, and can be divided into three main areas that would help patients towards greater therapy adherence:
#1: Consider and involve the reader
Using simple language isn’t easy, especially when medical terminology is needed to describe conditions or needed patient actions. The problem of simplicity in language is made more complex because experts in a given field use medical terms every day and include industry jargon as part of their natural vocabulary.
- Try running written instructions or information through a tool such as the Simple Measure of Gobbledygook, or the readily available online Hemingway Editor, which will highlight areas of complexity and return a reading-age score.
- Include a glossary of terms (along with phonetic pronunciations) to help patients grasp medical names and terms.
- Include visual representations of numerical data, and avoid switching between percentages and fractions.
#2: Make the design accessible
Adherence depends on a little more than reading age and health literacy. Layout, colours and white space can also improve understanding:
- Use a large font so those with sight challenges can also read it.
- Leave plenty of line spaces, and avoid splitting words across lines.
- Consider alternative formats for different patient segments. Adherence can sink when the ways in which information is accessible are limited. Not everyone goes online or downloads apps to a smartphone.
- White space is OK!
#3: Test, test, test
Engaging more effectively with patients often means being more specific in the questions asked. For instance, instead of asking patients if they understand the information you’ve just given them, ask them what tests they need, or how often they need to take the pink pill. Listening to answers from several patients will reveal whether there is a general understanding of information as it’s currently given.
Conducting simple question and answer sessions like this can aid in producing medical information that patients need the most. It can also inform decisions regarding format, and give insights into just how complicated or simple the language needs to be.
When therapy adherence is improved, patients’ outcomes are improved. But also, we can reduce health care costs by creating higher awareness of health issues along with improving quality of life for patients with complex conditions.
A simple checklist when producing patient materials can help keep developers of informational content on track. At COUCH, we understand the burden of literacy levels on patients, and have produced just such a checklist through our work with patient groups. Involving patient groups highlights their areas of misunderstanding or concern, showing us where to focus more effort in producing the kind of support materials that really make a difference.